|
SCHOOL YEAR FROM SEPTEMBER, 200_ TO JUNE, 200_
|
Date: ______________________________
Last Name _______________________________ Gender _____
Child's Name ____________________________ Birthdate
_______________(m/d/y)
Address ____________________________________ City
_____________________
Postal Code __________________ Telephone
(_____)____________________
Mother's Name ______________________________
Occupation ___________________________
Business Address ____________________________ Business Phone
(____) __________________
Father's Name _______________________________
Occupation ___________________________
Business Address ____________________________ Business Phone
________________________
Marital Status ___________________
Siblings Name ______________________________________ Birthdate
______________________ (m/d/y)
Name Siblings ______________________________________ Birthdate
______________________ (m/d/y)
Name Siblings______________________________________ Birthdate
______________________ (m/d/y)
IN CASE OF EMERGENCY
Name ______________________________________ Phone (____)
__________________
Name ______________________________________ Phone (____)
__________________
Pick-up Authorization:
___________________________________________________________________________________
Allergies or Health Problems of which you wish the school to be aware:
___________________________________________________________________________________
Health Card #:
________________________________
____ Pickering Campus Pickering (415 Toynevale Ave)
____ Rougemount Campus Pickering (365 Kingston Road)
____ Village Campus Ajax (56 Old Kingston Road)
____ Milner Campus, Scarborough (885 Scarborough Golf Club Road)
____ Westney Campus, Ajax (20 O'Brien Court)
I have read and understand Blaisdale Montessori School’s Terms &
Conditions.
Signed: ______________________________________________
|
|
Please Read
Application Thoroughly.
THIS FORM MUST BE RETURNED TO THE SCHOOL
Make sure you read the Terms & Conditions
|
Please
proceed to the Following Page: Statement of Account
|
